Drug Therapy for Essential Tremor Amber Le Roy

Drug Therapy for Essential Tremor Amber Le. Roy, Student Nurse Pathophysiology v v v v Progressive, involuntary movement disorder of unknown cause Can effect arms, hands, head, voice, trunk, and legs Lacks a specific set of diagnostic criteria Postural Tremor present when trying to maintain posture or elevating extremities Kinetic/Intention Tremor present when preforming an action Shaking/trembling extremities Progression of ET can lead to cognitive changes, depression, social phobias, anxiety, impaired gait Treatment v Very limited v First Line Agents: Ø Propranolol (FDA approved) Ø Primidone v Second Line Agents: Ø Anticonvulsants (Gabapentin, Topiramate) Ø Short-acting benzodiazepines (Alprazolam) Clinical Significance v v https: //www. pinteres t. com/pin/473229873 318127925/ Etiology v Precise etiology is unknown v Hereditary 50 -60% first degree relatives with ET v Origin: cerebellum or cerebellothalmocortical pathway v v v Propranolol: nonselective beta-blocker Ø Therapeutic doses are patient-specific Ø Used for daily maintenance and suppression of ET Ø Adverse Effects are bradycardia, lightheadedness, fatigue, headache, and impotence Primidone: anticonvulsant Ø Found equally effective as propranolol but has acute toxic reactions Ø Long-term tolerability is greater Gabapentin: anticonvulsant Ø More beneficial when used with propranolol or primidone and is well tolerated Topiramate: anticonvulsant Ø Approved for epilepsy and migraine prophylaxis Ø Not as effective as others and high incidence of adverse effects Alprazolam: short-acting benzodiazepine Ø Not as effective and adverse effects Ø Used cautiously due to dependence and abuse Conclusion v Testing continues due to mixed results and poor success with therapies thus far v Currently 30 clinical trials are being conducted for other possible drug therapies Ø Carisbamate Ø Pregabalin (Lyrica) v Current Interventions: Propranolol or Primidone, encouraging proper sleep, avoidance of caffeine, cigarettes and reducing stress v More studies are needed in the areas of etiology, genetics, and potential treatment for ET http: //www. nursingcent er. com/cearticle? an=000 06205 -201006000 -00008 References De. Simone II, E. M. , & Crimmins, J. M. (2011). Essential Tremor: A Common Disorder With Limited Treatments. U. S. Pharmacist, 2011(36), 3 rd ser. Retrieved February 28, 2016, from http: //www. uspharmacist. com/content/t/neurology/c/27006/